We need a human touch on the pathway to dying

I find it ironic that this attempt to spread into hospitals the compassion we associate with hospice care has triggered such a furore. But I'm not really surprised.

Since forever, the terminally ill have taken pot luck with the care they received in their last few days and hours in hospital. Too many realised their prognosis only when the morning ward round skipped their bed. Too many breathed their last while wired up to bleeps and monitors, pin-pricked by injections and trundled along passages for yet another pointless scan or X-ray. How many went through operations that hadn't a prayer of lengthening their time on earth? How many were in pain? We'll never know. But these deaths didn't attract our fury because to the relatives it looked as if everything possible was being done to preserve life.

Now hospitals are openly acknowledging that there is a limit to their powers. They're accepting that we are mortal and they are doing their best to help us through our final hours with as much dignity and as little pain as possible. How can this be a bad thing?

With a bit of luck we and our loved ones will benefit from it. I say with a bit of luck because the very thing that will carry us peacefully from life is now under attack.

We are hearing stories about patients who were denied food and water only to revive when families took direct action. We're hearing of people being on the "death path" without their families knowing. The stories are appalling and they deserve to be aired. But these are exceptions to the rule. We are hearing about poor practice, incidents where the code was wrongly or badly applied. Let's not lose the pathway because some have veered from it.

As I write I'm looking at a document supporting the Liverpool Care Pathway signed by 22 organisations including Marie Curie, Macmillan, Royal College of Physicians, Royal College of General Practitioners, Royal College of Nursing, Age UK, Motor Neurone Disease Association, the Multiple Sclerosis Society and on and on and on. I find that a calming thought.

It describes the LCP as offering medical professionals a caring framework within which they can help terminal patients to the most dignified and comfortable end possible. The decision to place someone on the pathway must be taken by the most senior doctor available in consultation with other staff and with the patient and the family. And because doctors are not infallible (people can rally against all the odds), the situation is continually evaluated.

The LCP is not designed to hasten or delay death and it doesn't preclude people being given food or drink – though it's the clinician who decides whether this is in the patient's best interest.

I have seen it in practice and heard a personal account of it. In both the cases death was dignified and pain-free. It was the best possible option for the patient. What could have been better was the way it was handled. On one occasion I saw the decision to enter the pathway negotiated by a doctor with the charm of a bloodhound. It took her approximately three minutes to boom the bad news at the unsuspecting patient. She then departed without a word to the family, leaving rage and dismay in her wake.

Had she taken a seat, lowered her voice, given everyone a moment to absorb the shock and to formulate questions, the experience would have been so much kinder and the memory more bearable.

The care that was then given to the patient was excellent but the family would have had more personal attention in a supermarket. Yet hospitals must know that people are in a state of heightened awareness and in emotional pain. Shifts changed, staff came and went efficiently. What was conspicuous by its absence was any personal touch. I know it is difficult to walk a line between interest and interference, but there was no hand on the shoulder and no verbal equivalent.

I'm convinced that much of the present furore is a response to that.

We have grown soft. In my mother's day and in my childhood people were born at home and died at home. Families understood the processes.

Death has become a mystery. It's hidden away and never spoken of. We've forgotten that it can be a cruel business and it won't always bend to our will. Too often we witness the final days and hours of someone we love with no understanding that this too is a process. It has phases and stages that the professionals recognise but that fill us with helpless panic that can translate into anger. We want someone to blame.

There are bereavement counsellors in midwifery who will work with parents whose baby is unlikely to survive. They attend the delivery and stay in touch with the family through the funeral and for about six months thereafter. It is a hugely beneficial service.

Ideally a form of it would be available for all bereavement. There would be a designated, trained person looking in on each family as their loved one was dying. It would avoid the distress and shock we are hearing expressed at the moment.

There is hope. One professional explained to me that new medical students are being assessed for emotional intelligence as well as academic ability. Hallelujah. She said: "You won't remember the nurse who gave you the injection but you will remember the one who smiled and asked you how you were." You will indeed. And there is hard evidence to support the idea that when we feel emotionally supported, we heal better and faster.

In the same way, we accept loss and recover from bereavement when we feel assured that everything that could be done was done. It means giving treatment when it has a chance of prolonging life and stopping it when the only hope is for a good death.

But if the Liverpool Care Pathway is to survive intact, the medical profession needs to get better at caring for the family as well as the patient.

Perhaps the other half of the equation is up to us. Death remains a mystery but the process of dying needn't be. We can read up on it, inform ourselves, prepare, in the sure and certain knowledge that one day we'll need it.